Social and health care | Ethical stress is burdensome, says the doctor: “The polyclinic was constantly under pressure to sign patients out”

If the patient has difficult problems, it is not allowed to spend enough time to solve them.

Among other things, this is how it describes Antti Friman his experience of what his work as an occupational health doctor at the sick reception is like.

Friman is one of many Finnish doctors who have experience working in both public health care and private occupational health care. For the past year, he was working at the Kalasatama psychiatric outpatient clinic in the city of Helsinki. He is currently working at Terveystalo.

According to Friman, working at the psychiatry outpatient clinic was extremely stressful. Friman is a doctor specializing in occupational health care, and he wanted to gain experience in psychiatry.

The workload turned out to be heavy primarily because the city had not managed to find any psychiatrists for Friman's team. Friman praises the fact that he was given job guidance once a week and that his supervisor was available by phone. However, this did not replace a permanent on-site psychiatrist.

“When I know how demanding the work of a supervisor is, I didn't want to be bothering my supervisor all the time. Matters in psychiatry are also often so complicated that they cannot be resolved with a very short call.”

At the end of the workday, Friman was tired.

“A lot is taken out of the specialist doctor, because it seems that they are the only employees who can be hired easily.”

Freeman's the experience is not rare, but it describes the big difficulties of the Finnish social security system.

Employers in the public sector, i.e. welfare regions and the city of Helsinki, find it difficult to find staff. Expanded occupational health care organized by private companies has succeeded in attracting doctors.

When the public sector cannot hire its own doctors, we have to fix the situation with expensive hired doctors. Statutory services must be produced, so it is difficult to curb the use of hired labor.

Due to the labor shortage, public services are also cut. Many welfare regions have made decisions about closing health centers, for example.

In January, the civil service working group set up by the Ministry of Social Affairs and Health (STM) proposed cutting hospital on-call appointments. The proposal would, for example, concentrate births in fewer hospitals. The working group based its presentation specifically on the personnel situation. The most pressing shortage in Finland is nurses, but the public sector also suffers from a shortage of doctors.

Scarcity of money leads to cutbacks, but the labor shortage is considered an even bigger prob
lem in welfare areas.

In an interview with HS in December, Director General of the Institute of Health and Welfare (THL). Mika Salminen said that in addition to cutting hospitals, Finland should seriously consider the status of occupational health care. According to Salminen, it currently captures the doctors for themselves in a way that erodes public health care.

Labor shortage is currently being approached in the Ministry of Social Affairs and Health by preparing a “good work program”.

One of the goals of this work is to find ways that welfare areas could strengthen their “attractive and holding power”. That is, how they could attract more employees and keep the existing employees on the payroll of the welfare area.

Antti Friman emphasizes that his experience concerns only one office, and it does not tell about how things are in general at the psychiatry of the city of Helsinki. However, his experience shows how recruitment problems and too few personnel are reflected in the doctor's workload.

The problems are not only caused by the recruitment problems of one individual unit, but also by the fact that social and health services in general suffer from weak resources. When one point is blocked, it is visible in other services.

“Patients have really difficult problems on the mood disorder line. Ward periods are short, so outpatients are in pretty bad shape. When working with population responsibility, there is constant pressure to treat as many patients as possible,” says Friman.

Operating with population responsibility means that a certain unit must treat all patients from a certain geographical area.

The requirements for treatment are tough, says Friman.

“What society promises in the appropriate care recommendations is sometimes really difficult to implement. In basic health care and psychiatry, there are jobs where society's demands on the employee are completely unreasonable compared to the number of staff with which the treatment is carried out.”

According to Friman, one burdensome factor is precisely ethical stress, i.e. not being able to do the work as well as it should be done.

“The polyclinic was constantly under pressure to sign patients back to primary health care. It was emotionally taxing because the patients' mood disorders are often long-term and they would probably benefit from our treatments. Even the patients know that the health center does not have the same psychiatric work group as the outpatient clinic, and many feel that it is a weakness.”

Friman says that he has had a better sense of control over his own working days while working in occupational health care. On a general level, the problems of patients in occupational health are easier than in public primary health care. According to Friman, occupational health care also receives patients who have very demanding problems related to the ability to work. However, you get more time to take care of them.

“

“Stress just becomes too much.”

At Terveystalo, Friman has also been able to influence his own workload and the planning of working days.

“In occupational health, you may not always even get a better salary than in the public sector. But in most workplaces, you can plan more of your working day yourself. At the health station, a completely different person plans the basis for the doctor's working day.”

Sure There are health centers in Finland that work well, says Friman. In many places, however, it is difficult to get long-term doctors, and it is ruining the operation of the entire health center.

When there are no experienced doctors in the work community, new employees do not have someone to ask for help in difficult situations. According to research, the treatment is also more effective when the same patient is treated by the same doctor for a long time.

“When the patients' problems are often still very complex, the work becomes unmanageable. The stress just becomes too much.”

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Update 3.2. at 9:56 am: Information about where doctors work has been added to the fact box.